Corneal injury

Swarupmay Majumdar A pug, 4 months female, wt 7kg, history of being unable to open his eyes for last 2 days.
PE: All parametrs normal. Eye exam: Cornea injured by blunt injury. ulceration and opacity to some extent. No FB noticed.
How do I treat it?
I have put it on Oral Amoxyclav, Prednisolone 1% eye bid, tear natural Bid , and Ciprofloxacin eye 5 times. any suggestions? Can I use Placentrix? if so how do I use it?

02 August at 14:00 · Comment · · Flag

• • 

    Gagan Gaudi u r saying corneal ulceration and still using prednisolone. stop prednisolone immediately if there is ulceration.
    

    02 August at 14:04 · ·
  • 

    Swarupmay Majumdar ok. but how do I manage this case? can u suggest me plz

    02 August at 14:07 · ·
  • 

    Gagan Gaudi go for ofloxacin eyedrops every 2 hrs. if there is pain go for diclofenac eye drops otherwise ofloxacin will take care in a day or two but stop steroids immediately it will worsen the case
    

    02 August at 14:08 · ·
  • 

    Swarupmay Majumdar ok, thanks

    02 August at 14:09 · ·
  • 

    Gagan Gaudi have to continue ofloxacin for a long period of a month or so
    

    02 August at 14:14 · ·
  • 

    Rajshankar Tony Sarma

    Antibiotic drop, topical NSAID as Gagan says and tear replacement as necessary. Next question is "why did this happen"? Pugs are prone to a number of keratitis types - exposure, distichiasis, eyelid conformation problems leading to hair hitting eyes, etc. etc.
    
    Personally I use BID-TID fucithalmic and whichever topical NSAID is on the shelf. Not convinced about fluoroquinolones for basic conjunctivitis.

    02 August at 14:35 · · 1 person ·
  • 

    Gautam Unny

    i dont like using predinisolone in cases of corneal injury. i avoid it like the plague. also my drug of choice in any eye case is doxycycline @ 10mg/kg.
    yes subconjunctivalplacentrix or even a drop of animals own serum injected sub cut below the eyes has terrific results.
    
    and never forget to tape the inner dewclaws and use a e collar.

    02 August at 15:41 · · 2 people ·
  • 

    Rajshankar Tony Sarma Not tried placentrix, but serum works very well. Don't normally use it routinely, personally, but definitely an idea for difficult ulcers.

    02 August at 15:44 · ·
  • 

    Amber Mishra please post the pic at Savin Doc...

    02 August at 17:27 · ·
  • 

    Swarupmay Majumdar No Pic doc! I dont have camera at clinic!

    02 August at 17:28 · ·
  • 

    Ankur Sharma

    We had a similar corneal injury case in a adult pug, resulting into ulceration, used gatifloxcin eye drops qid and ciplox ointment at night for about a 20 days+ Tab augmentin bid for 7 days... it has healed properly..
    
    Corticosteroids are contra-indicated in corneal ulcers, kindly dont use them

    02 August at 17:28 · · 1 person ·
  • 

    Premal Darji serum is given subcut below eye or subconguntival...

    02 August at 18:20 · ·
  • 

    Sajayan Sahadevan I suggest u give Augmentin bid for 5 or 7 days and Steroid in tapering dose(only parenterally since it has corneal ulcer) and multivitamin tab(should contain vit.A and vit C).In my opinion and exper, only corticosteroid eye drops should be avoided n corneal ulcer .I also suggest saline eye drops.Kindly inform the progress of the case and the treatment u choose ultimately.

    03 August at 05:36 · · 3 people ·
  • 

    Peter Nolosco

    From your narration I could conclude this could be a case of superficial ulcer and pugs are more prone to Exposure keratitis due to its anatomical predisposition.
    I suggest to anaesthetise the animal and cauterize the ulcer edges with diluted povidone iodine using cotton tipped applicator then put temporary tarrsoraphy with slightly opened medial canthus for installing eyed drops.
    -Antiobiotic drops preferably neomycin - polymyxin - bactracin drops (broad spectrum very effective)
    -1% Atropine eye drops
    - Autogenous serum
    and the above can be installed in to the eye through the slight opening in the medial canthus after tarrsoraphy daily at 3 to 4 hr interval with atleast 10 minutes gap between each topical medication for 2 weeks.
    Tarrsoraphy has to be removed after two weeks to evaluate the condition.
    Oral vitamins will be additional supplement.
    Tarsoraphy is essential to avoid keratoconjunctivtis sicca.

    03 August at 10:21 · · 2 people ·
  • 

    Rajshankar Tony Sarma

    Augmentin... This is an interesting one. Augmentin given PO systemically will reach the eyelids, but to achieve bactericidal concentration at the cornea (where the ulcer is) is unlikely unless there is significant neovascularisation - which itself we will want to remove eventually. Topicals are therefore more reliable.
    
    Saline is reasonable to moisten the eye, but is removed almost instantly - true tear replacements will last at least 2 hours and are therefore preferable if available.
    
    Furthermore, there is an ongoing concern with augmentin in referral institutes where TID intravenous augmentin is a regular approach. Augmentin is a time-dependent antibiotic, therefore its rate of bacterial kill is dependent on the time for which the antibiotic is above the minimum inhibitory concentration for the bacterium concerned. Should it fall below MIC regularly through therapy, then you are at increased risk of encouraging development of resistant isolates.
    
    As such, are there any studies to show how long augmentin is above MIC in the various tissues in the dog after a single injection? Answer is no. The TID dosing strategy is an extrapolation from human medicine.
    
    Furthermore, it has been shown that intra-operatively, a 20mg/kg IV bolus of augmentin has a half-life of 1hr in the dog. As such, it is repeated every 1-2 hours intraoperatively.
    
    Now, it strikes me that if it is needed every 120minutes intraoperatively, then to recommend giving it every 8 hours, we need to know what MIC we are trying to achieve with each dosing strategy, or have a study showing how long the levels persist for after IV injection. Neither are available for our patients.
    
    I therefore prefer PO dosing, or in well-hydrated patients, depo (q24hrs) dosing of a longer-acting formulation such as synulox - at least I know how long my antibacterial effect will last!

    03 August at 10:27 · ·
  • 

    Rajshankar Tony Sarma

    Peter - do you routinely treat that aggressively at first consultation? It'll definitely work (and I agree on tarsorrhaphy in pugs!); I've usually played it more conservatively and gone for the approach you describe if no improvement is seen after 5-10d.
    
    I guess the argument is that in a pug, more persistent problems are possible therefore more aggressive management can be considered?

    03 August at 10:31 · ·
  • 

    Swarupmay Majumdar Synulox is no more avl in india. Agumentin inj is no way near Synulox.
    But leave aside pugs, how do we really handle Corneal ulcerations or injuries?

    03 August at 10:42 · ·
  • 

    Sp Singh

    Why leave pugs --- let the discussion continue doc.
    I use tobramycin q3h (for me frequency of installing eyedrops matters a lot)and saline wash.serum is a good option for chronic ulcers ---no matter what you do it take long time for the ulcers to heal so do not get shaken by the owners impatience and start an aggresive treatment for early results.

    03 August at 11:08 · · 1 person ·
  • 

    Rajshankar Tony Sarma

    ‎^I think the key there is "chronic ulcers". I'd always be aggressive and do a keratotomy / serum for a long-standing ulcer; in most breeds, an acute ulcer can be managed with analgesia / antibiotic topicals alone over 7 days.
    
    Deep/melting ulcers and chronic ones are a different matter; in a pug, the exposure factor also means healing may be slovenly as for "indolent" ulcers in boxers etc. Thinking about it, for acute superficial ulcers, I usually warn the owner of the possible problems in healing, but start with topicals only over a week; if no improvement is seen, I'll GA and debride, serum etc.
    
    We have an ophthalmologist, so see a lot go to surgery as referrals; however checking through the first-opinion practice records, only 5 have gone through to anaesthesia in the last year - and we get at least 3 acute corneal ulcers per month. Speaking to ophthalmology and first opinion, consensus is that treating with topicals and analgesing alone is a reasonable first step as long as there are no underlying problems.
    
    This brings us back to the pug example. On that, the jury is out - suggestion is that it can be managed either way as long as the owners know that with ga/serum etc, it may be overkill; or with basic management it may not heal.

    03 August at 13:07 · ·
  • 

    Swarupmay Majumdar This is not so bad case, I think this was not requiring the operation. but should have not used th predni!
    I will be able to tell about him in 2 days
    

    03 August at 13:13 · ·
  • 

    Rajshankar Tony Sarma I should add that the ophthalmologist's view is that most pugs could do with some eyelid surgery!

    03 August at 13:58 · ·
  • 

    Gautam Unny the best way is to do a tarsoraphy very early in mild cases but rarely do clients ever agree. in worse cases i prefer making corneal flaps with tarsoraphhy but there again somehow clients are afraid when it comes to eye surgery

    03 August at 15:17 · ·
  • 

    Swarupmay Majumdar Update: Just seen the pup! Wonderful, he is fine, condition improved by 80%. We stopped the Pednisolone as advised and now continuing with Tear natural and ciproflozacin eye drops. will update u agin on Satday

    04 August at 16:07 · · 2 people ·